Direct posterior restoration and internal fixation technique for children with congenital atlantoaxial subluxation

Objective To explore the clinical effect of direct posterior restoration and screw-rod (plate) internal fixation technique for the treatment of children with congenital atlantoaxial subluxation.Methods Seven children with congenital atlantoaxial subluxation,admitted to our hospital from April 2008 to March 2011, were chosen in our study; and 3 of them were combined with tonsil hernia of cerebellum and 3 with occipitalization. Japanese Orthopedic Association (JOA) scale was used to evaluate the patient's condition. Five patients were treated by internal fixation with occipital bone screw-axis (C2) pedicle screw and 2 were with atlas C1-C2.Articulatio atlantoepistrophica repositioning was performed during the operation. The post-operative improvement degree and therapeutic effect of these patients were assessed based on the JOA scores and imaging. Results All the patients were followed up for 1-15 months (average 3.2 months). The clinical symptoms of all patients improved significantly. The positions of all screws were fine 1 month after operation. Three-dimensional CT showed that occipital/interbody fusions were good in 3 patients.JOA scores after the surgery were 7-16 with an average scores of (12.03±3.58),which were significantly different as compared with those before the surgery ([7.56±3.16], P＜0.05). Conclusion Direct posterior restoration and internal fixation technique is a safe and effective method for the treatment of children with congenital atlantoaxial subluxation. Key words: Joint instability; Restoration; Bone screw; Titanium; Intemal fixation